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ENSO Recovery takes lead sponsorship role to support the Maine Sheriffs Association Annual Conference.

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Slide1:

A CULTURE OF COMPASSION, CREATIVITY, COMMITMENT AND  COMMUNITY Specializing in Outpatient Medication Assisted Treatment and Recovery for Opioid Use disorders

Slide2:

ENSO Recovery Medication Assisted Treatment and Recovery Programs Sanford Office Program Type: Outpatient Opioid Addiction Clinical Services: Intensive Outpatient, Co-Occurring Disorders, Outpatient, Aftercare, Counseling, Groups, 12 Step Meetings Medical Services : Suboxone, buprenorphine, Vivitrol 69 Eagle Drive Sanford, Maine, 04073 Ph.: 207-324-4054 Portland Office Program Type: Outpatient Opioid Addiction Clinical Services: Intensive Outpatient, Co-Occurring Disorders, Outpatient, Aftercare, Counseling, Groups, 12 Step Meetings Medical Services : Suboxone, buprenorphine, Vivitrol 103 India Street Portland, Maine, 04101 Ph.: 207-245-1800 Payment: MaineCare, Commercial Insurance, Self Pay, Grants Licenses : Mental Health & Substance Use

Slide3:

We believe that substance use disorder is a healthcare issue not a criminal nor moral issue. We believe that addiction is a complex, multidimensional  psychobiosocial phenomena and that we must understand the underlying pain to understand the addicted individual. We believe the trauma that propels one into addiction must be explored, exposed and addressed to achieve recovery. We believe an empty sense of hopelessness, an alienation from ones self and ones world permeates the souls of those suffering from addiction and the addiction is merely a biological byproduct of their despair. We believe that recovery has many faces and that medication assisted recovery is one. We believe an individual has the right to define their own recovery. We believe that ones choices and ones self acceptance determine their happiness. ENSO RECOVERY

Project Restore A Collaborative Diversion Project for Offenders With Substance Use Disorders:

Project Restore A Collaborative Diversion Project for Offenders With Substance U se Disorders Our Partners

Slide5:

Enso Recovery Cumberland County Sherriff Office Classification Pre-trial Status Probation Sentenced TX Groups once a week . Level of care assessments Transition plans for discharge from incarceration TX Groups once a week . Level of care assessments Transition plans for discharge from incarceration TX Diversion Sample Pat h way to T reatment via C ase Man a gem e nt

Treatment Groups :

Treatment Groups Conduct psycho-educational groups inside pods in the jail that target the male and female population. This will be done using a curriculum driven course that is specifically designed for this particular population. It will focus on education around substance use disorder in the brain, repairing familial relationships, treatment options for post incarceration, dealing with triggers and cravings, criminal addictive thinking in relation to substance use.

Level of Care Assessments :

Level of Care Assessments Conduct comprehensive assessments for individuals identified through self-report, institutional referral, or mental health referral. These assessments would be conducted within the jail during a specific time after groups. We would use assessment tools to help us understand inmates current or recent use, living arrangements, vocation, natural supports, all information used to formulate a diagnosis and assess need for treatment. This can be used to help facilitate a better plan and understanding of needs and can potentially decrease the amount of time spent in jail if inmate is waiting for community treatment. We would also work with sentenced inmates before their release date to increase the continuity of care post incarceration.

Transitioning Process:

Transitioning Process With Enso Recovery working with Cumberland county jail we will be able to begin treatment the moment that they leave the jail. With no unforeseen barriers, their assessment and start of treatment would be on the same day of their release. Enso will provide intensive out-patient t reatment 5 days a week, individual counseling and medication management as required.

Potential Outcomes :

Potential Outcomes Reduce recidivism by connecting individuals with a substance use disorder to treatment provider in their community sooner due to early interventions in the jail . Provide useful psychobiosocial education to incarcerated individuals that may impact future decisions. Reduce barriers to entering treatment upon release for individuals through timeliness of delivery of services. Collaborate with institutional providers to ensure a quality of care continuum while incarcerated and upon release.

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Solu t io n s to Our Natio n ’ s Op i oid C r is i s T h e Naloxone Plus Pr e- Arrest Dive r sion Framew o rk Ja c Ch a rlier N a tio n al D i rect o r f or J u stice In i tiativ e s jc h ar l i e r @ tasc . org 31 2 - 573 - 8302 © 2 2 De c e m be r 201 7

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The Nal o xone Plus Fram e work: Designed for Saving Lives – T wice

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N a lo x one Pl u s : E ngage m en t w ith tre a tme n t a s p a rt o f a n ov e r do se res p o n se or DS M -V sev e rity for o p i a tes; tig h t i n te g rati o n w ith tre a tme n t, n a l o x o n e (i n d i vi d u a l to o ) A ct i v e O u tr e a c h: L a w e n forc e me n t i n te n tio n a l ly IDs or s e eks i n d i vi d u a ls; a w a rm hando f f is m a d e to tre a tme n t, w h ich engage s i n d iv idua ls in tr ea tme n t S e lf-R e fe r r a l: In d iv i d u al i n iti a tes co n tact w ith l a w e n forc e me n t for a tre a tme n t ref e rral ( w ith o ut fe a r of arr e st); pr e fer a b l y a w arm h a n d o f f to tre a tme n t Offic e r P re v e ntion R e f e r r a l: La w en forc e m en t i n iti a tes tre a tme n t e n g a g e me n t; no ch a rg e s are f i l ed Off i c e r I n te r v enti o n R e fe r r a l : L a w e n forc e me n t i n iti a tes tre a t m e n t e n g a g e me n t; ch a rg e s are h e ld in a b e y a n ce or cit a tio n s iss u e d , w ith r equ ir e m en t for c o m p l e ti o n o f tre a tme n t Five Pre - Arr e st Div e rsion Framew o rks: Pathways to T reatment ( Do T hem All)

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A n g el (M A ) / A rli n gt o n (MA) – pa a riusa.org (2 5 0+ sites for A n g e l a n d Arl i n g ton pr o gr a ms – PD, Sh e ri f f, F ire a n d ot h er) S e l f- r e ferr a l, Acti v e Outre a ch Ci v il Citation (FL) – civ i lc i tati o n n e t w ork.c o m (62 sites: 61 juv e n i l e , 1 a d u lt) O f ficer Interv e nti o n R e ferral D A RT (OH) – lcs o d a rt . com (ma n y a n d var i ed sites) N a l ox on e P lu s LE A D ( W A) – l e a d ki n gc o u n t y .org (7 sit e s) O f ficer Prev e nti o n R e ferral STEER (M D ) – C e nt e rforH e a l th a n d Justic e .org (1 sit e ) N a l ox on e P lu s, O f fic e r Pr e v en ti on /I n terv e n ti o n R e ferr a l Pre - Arrest Divers i on Examples (Brands) w i th Relat e d Fra m e w ork

Elements of the Naloxone Plus Framework:

N a l o xone Plu s : E n g a g e me n t w ith tre a tme n t as p art of an ov e rd o se res p o n se w ith n a l o x o n e, th e n fol l o w i n g up ra p i d ly w ith tig h t i n te g rati o n w ith tre a tme n t. Site e x am p l e s: DA R T , S T EER, Q R T Nalox o ne – Law enforcement, fire, emergen c y med i cal serv i ces, communit y , bu s ine s ses, individual s , et c . Rapid ID – e.g., 9 - 1 - 1 Im m edia t e co n tact w ith in d i v id u a l – as close as po s sible to point of O D Ra p id e n g a g e m e n t – in pe r son and daily fol l o w - up until engaged in t r eatment Rapid access to treat m ent – mea s ured in m i nutes and hours Sc r eening and clinical assessment – to ha v e the cor r ect individual app r oa c h Co n ti n ued ti g ht in t egrati o n – poli c e and beha v ioral hea l th and c ommunity Med ica t i on - A s sis t e d T reat m e n t (M A T ) – all app r op r iate medi c ations made available Reco v e r y su p p o rt ser v ices – treatment end s, re c o v ery c ontinues Nalox o ne – for the individual and his/her househo l d Ele m ents of the N aloxone Plus Fram e wo r k

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Imple m enting the Naloxone Plus Fra m ew o rk

The TASC Model Pathway to Treatment via Case Management:

The T ASC Model Pat h way to T reatment via C ase Man a gem e nt

Slide17:

Sou r c e : C o mmu n ity C a ta l y st, 2016

Signs of Recovery Over Time:

© 2014 Signs of R ecovery O ver T i m e Du r ation of A bstinence 1 -3 Y ears 1 - 1 2 Mont h s 4 -7 Y ears More ab s tinent friends Le s s illegal act i v i ty and i ncarceration Le s s home l essne s s, violen c e, and victimization Le s s use by others at home, w ork, and by social peers V irtual elim i nat i on of illegal act i v i ty and i llegal income Better hou s ing and living situat i ons Increas i ng emplo y ment and income More social and s piritual suppo r t Better mental hea l th Housing and l iving situat i ons cont i nue to improve Dramatic ris e in emp l o y ment and i ncome Dramatic drop in peop l e living below the po v erty line So u rce : D en n is, Foos & Sc ott , 2 0 07

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The Opioid E pidemic

Drug Deaths Surpassed Gun and HIV/AIDS Deaths in 2015:

Drug De a ths S urpas s ed G un and HI V /AIDS De a ths in 2 0 15 D rug O D s 2015 H IV/AI D S 1995 C ar crashes 2015 Gun deaths 2015 Gu n ho m icides 2015 S o u r c e: Re i c h a rt 2 0 17 (2 0 15 CDC d a ta)

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Opio i d Deaths C ontinue D ramat i c R ise S o u r c e: NID A , 2017

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State Significant Change DC Yes 108.6 MD Yes 58.9 FL Yes 46.3 PA Yes 44.1 NJ Yes 42.3 DE Yes 40 ME Yes 35.4 VA Yes 34.7 IL Yes 34 VT Yes 32.9

Slide24:

State Rate Number WV 52 884 OH 39.1 4,329 NH 39 481 DC 38.8 269 PA 37.9 4,627 KY 33.5 1,419 MD 33.2 2,044 MA 33 2,227 DE 30.8 282 RI 30.8 326 ME 28.7 353

Opioid Overdose Incidence: 2016 - 2017:

Opioid Overdose Incidence: 2016 - 2017

Slide26:

Pre-Arrest D iver s ion: A P ubl i c H ealth Solution for I m proved Publ i c Safe t y

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V ar i ety of T erms for Pr e - Arrest Divers i on D e flecti o n P o l i ce a ss i sted d iv e rs io n N o a rr e st L a w e n forc e me n t e n co u nt e r Pr e -arr e st L a w e n forc e me n t ass i sted d iv e rs io n Pr e -ch a rge Pr e -b o ok i ng

Promises of Pre-Arrest Diversion:

R e d u ced crime Impr o v e d pub l i c s a fety (r ea l an d pe rc e iv e d ) R e d u ced dr u g u se L i ves sav e d, liv e s rest o red B u i l d i ng p o l i c e -comm u n i ty re l ati o ns R e d u ced b u rd e n on crimi n al j u stice to so l ve p u b l ic h e a l th a n d soc i al ch a l l e n g e s B u i l d i ng p o l i c e -p u b l ic h e a l th/b e h a vi o ral h e a l th re l ati o ns C o rrect movem e nt of citiz e ns i n to/a w a y from t he justice s y stem C o st sav i n g s “N e t-n a rro w in g ” K e e p i n g fami l i e s i n tact Promises of Pr e- Arrest Divers i on

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Evi d e n c e -b a sed su b sta n ce use t re a tme n t in t he le a st restrictive e n vir o nm e nt (in t he commu n ity rat h er th a n j a i l ) Ev e ry p o i n t from pr e -arr e st to pr o sec u tion to a d j u d i cati o n pr o vi d es an oppo rtu n ity to d iv e rt s o m eon e to e vi d en c e - ba s e d tre a tme n t Interv e nti o n at the e a rl i est p o i n t p o ssi b le L a w e n forc e me n t res p o n se to me n tal h e a lth cris e s as a pr o o f - o f-co n ce p t for s i m i l a r r e s pon se to op i o id OD an d cr i s e s Opp o rtunit i es for Law E nforcement

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Pre - Ar r est Diversi o n ( P AD): Emergi n g I s s u e s a n d Example P oli c y Res p on s es J a c Cha r l i er N a tio n al D i rect o r f or J u stice In i tiativ e s jc h ar l i e r@tasc.org │ 3 1 2- 573 - 8302 v . 12.22.17

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Em e rging Is s ues a nd Example Policy Responses

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Emerg i ng Issues a nd Exa m ple Pol i cy Res p onses N e w l y e m e r g i n g fi e ld States e x p l or i ng w a y s to b o lster pr e -arr e st d i vers i on in p o l i cy re l at e d to: L a w e n forc e me n t g u i d a n ce a n d p rot e ctio n s A u th o ri za ti o n an d ev a l u a ti o n Fu n d i ng a n d tre a tme n t ca p ac i ty H e a l thc a re a n d tre a tme n t fin a nc i ng via i n sur a nc e /p a y ers/MCOs C o nne cti o n to c a re f o l lo w i n g OD r e v e rs a l R e p o ns e s pr e se n ted w ith o ut e n d o rsem e nt of a n y p a rticu l ar a p pr o ach

Law Enforcement Guidance and Protections:

Law Enforcement Gu i dance and Protect i ons Is s u e : No f orm a l pr o tecti o n or g u i d a nce for l a w e n forc e me n t w ith res p ect to p r e - a rr e st d iv e rs ion , h i n de ri n g i mp l e m en tati o n o f P AD e f forts Prov i de immu n ity from l i a b i l ity in f ut u re c a ses of o f fe n ses comm i t t ed by d i vert e d i n d i vi d u a ls Articu l ate d i vers i on pr o toc o ls (e. g ., SB 1 2 0 in K Y , 2 0 1 7 ): A u th o riz e d l a w e n forc e me n t a g e n ci e s to cre a te a p ro g ram to ref e r p e rso n s w ho vo l u n tari l y se e k ass i sta n ce to tre a tme n t S p ec i fied th a t a p ers o n w ho vo l u n tari l y se e ks ass i sta n ce from l a w en forc e m en t s ha ll no t b e p la c e d unde r a rr e st or pr o s e c u ted for p o ssess i o n , p a ra p h e rn a l i a, etc.

Authorization and Evaluation:

Authoriza t ion and Evaluat i on Is s ue : Pro g ram ev a l u ati o n is critic a l to e n sur i ng e f fective a n d fair d iv e rsi o n im p l e me n tati o n (may re q u i re a m a n d ate a n d fu n d i n g ) Le g isl a tive activity rel a ted to over s i g ht of e f for t s to ensure best prac t ices HB 2 (NM, 2 0 1 7 ): A u th o riz e d fu n ds to ev a l u ate S a nta F e L EAD SB 8 4 3 (CA, 2 0 1 6 ): A u th o riz e d $ 1 5 mi l l i on to cre a te a n d ev a l u ate L E AD p i l ot sites SB 12 0 (K Y , 2017 ): A u th o ri ze d s e l f- r e ferr a l d iv e rs io n p r og r a ms AB 3 7 44 (NJ, 2 0 1 6 ): A u th o riz e d l a w e n forc e me n t ass i sted a d d i ction a n d rec o very pr o gr a mmi n g CT 705 2 ( 2017 ): C o n v ene d a w o rk in g g r ou p to e x a m in e e x ist in g pr o gr a ms, i d e n tify b a rri e rs th e y fac e , a n d re p ort on f e a si b i l ity of state w i d e im p l e me n tati o n

Funding and Treatment Capacity:

Fu n ding and T reatment C ap a city Is s u e : C h a l l e n g es acc e ssi n g e x isti n g tre a t m e n t ca p ac i ty a n d b u i l d i n g n e w ca p ac i ty act as b arr i ers to ra p i d ly l i nk i ng p e o p le to tre a tme n t Fu nd i n g to a cc e ss, a l i g n , an d bu i l d c o mm un ity tre a tme n t c apa city an d tig h ten co n n e ctio n s w ith d i vers i on pr o gr a ms at: Interc e pt 0: P a th w a y s to tre a tme n t i n d e p e n d e n t of l a w e n forc e me n t Interc e pt ½: Prev e nti o n d e flecti o n (treatm e nt on d e ma n d) Interc e pt 1: Interv e nti o n d efl e ction (tre a tme n t on d e ma n d)

Funding and Treatment Capacity:

F u n d ing and T reatment C apacity Is s u e : Witho u t i n ce n tives, l a w e n forc e me n t a g e n ci e s may n o t pr i or i tize d i vers i on Inc e n tiv i ze l a w en forc e m en t d iv e rs io n p r og r a ms b y t y i n g l o c a l, stat e , o r fe d er a l fu n d i ng to d i vers i on metrics (sim i l a r to arr e st metrics a n d fu n d i n g ) Is s u e : Emp l o y ers ch a l l e n g e d by l i mited w orkf o rce A u th o rize or ma n d a te P AD to pr e ve n t crim i n a l rec o rds a nd a d dr e ss su b sta n ce use dis o rd e rs, as a w orkf o rce d e ve l o p me n t strate g y (e. g ., em p l o y ee ret e nti o n, stro n g l a b o r mark e t p o o l s, etc.)

Healthcare and Treatment Financing via Insurance/Payers/MCOs:

Healthcare and T reatment Financing via Insur a nce/Pa y er s / M COs Is s u e : Pr io r a u th o ri za ti o n and /or m ed ic a l ne c e ss i ty r equ ir e m en ts i mpo s e d b y ma n a g ed care or g a n iz a tio n s (MCOs) for b e h a vi o ral h e a l th serv i ces may im p e d e s w ift co n n e ction to tre a tme n t, es p ec i a l ly cruc i al after OD rev e rsal R e mov a l of pr i or a u th o riz a tion requ i rements for be h avi o ral he a lth treat m ent HB 1 (IL, 2 0 1 6 ) re q u i red rem o val of pr i or a u th o riz a tion for me d ic a tio n - ass i sted tre a tme n t (M A T ) S e ver a l MCOs (Ci g n a , A n th e m, a n d A e tn a ) h a ve rem o ved pr i or au th o ri za ti o n r equ ir e m en ts for M A T

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Healthcare and T reatment Financing via Insurance/Payers / MCOs cont . Is s u e : D i f fer e nt sta n d a rds us e d b y var i o u s MCOs/p a y ers to d e fine me d ic a l n e cess i ty can im p e d e a b i l ity to fac i l i tate acc e ss t o tre a tme n t R e qu ire M C O/p a y e rs u se a s pe cif i c, un iv e rs a l s e t o f sta n da r d s – HB 1 (IL, 2 0 1 6 ) re q u i red MCOs t o use the me d ic a l n e cess i ty sta n d a rds set by the Amer i can S o ci e ty of A d d i ction Me d ic i ne (ASAM) f or su b sta n ce use

Connection to Care Following OD Reversal:

C o n n ection to C are F o llow i ng OD R evers a l Is s ue : In d iv i d u a l s d i sch a rg e d from t he ER f o l l o w i n g an o p i o id OD rev e rsal w it hou t c onne cti o n to furt he r me d ic a l c a re o r su b sta n ce u se tre a tme n t. Fol l owing a p er i od of a b stin e nce d u ri n g an ER s t a y , i n d i vi d u a ls are h i g h ly susc e pti b le to su b se q u e nt/re p e a t OD. T em p or a ry i n vo l u n tary comm i tme n t fol l o w i n g o p i o id OD rev e rsa l , to ke e p i n d iv idua ls s a fe an d to a l l o w time f o r l in k ag e to c a re Incl u de o p i o id OD as crit e ri o n for i n vo l u n tary comm i tme n t w ith i n e x isti n g statute Pr opo se ne w /am e n d e x ist in g l e g is la ti o n to s pe cif i c a l l y a l lo w for i n vo l u n tary comm i tme n t p o s t -OD P o st-OD inv o l u nt a ry comm i tme n t th a t p ar a l l e l s p o l i c y , pr a ctices, pr o ce d ur e , a n d pr o tecti o ns of me n tal h e a lth i n vo l u n tary comm i tme n t

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C o nn e c t ion to C a re Foll o wing OD Re v er s al ( cont. ) B a ckgr o u n d i n fo on inv o l u nt a ry comm i tme n t A d miss i on of i n d i vi d u a l a g a i nst h i s/h e r w i l l to tre a tme n t Inv o l u nt a ry commitment for m e n tal h e a l th cris i s w h e n som e o n e is a d a n g er to h i m/h e rse l f or ot h ers 37 s t at e s a n d D.C. h a ve e n act e d i n vo l u n tary comm i tme n t statutes a p p l y i n g to i n d i vi d u a ls w ith s ub sta n ce u se d i s o r de rs a n d/ o r a l co h o l ism

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r:... CENTER FOR ( CH J ) HEALTH & JUS TI CE \.:. °:) AT T ASC W @ T A S C C H J

About the PTAC Collaborative:

About the P T AC Collabo r at i ve Fo u n d ed as the res u lt of the March 2 0 17 In a u g ur a l S u mmit he l d at Int e r na ti ona l Ass o ci a ti o n o f C h i e fs o f P o l i ce (IAC P ) P T AC In a u g ur a l S u mmit or g a n iz e rs: A d C a re Cr i mi n al Justice Servic e s, C4 R e cov e ry S o l u tio n s, C e nt e r for H e a l th a n d Justice at T ASC, C i vil C i tati o n N e t w o rk, Ge o r g e M a s o n U n iv e rs i t y , Int e r na ti ona l Ass o ci a ti o n o f C h i e fs of P o l i ce, a n d W est e rn C a ro l i n a U n iv e rsity N a med for t he col l a b or a tive re l ati o ns h ip b e t w e e n p o l i ce, tre a tme n t, a nd comm u n i ty n e cess a ry to make p o l i ce d i vers i on p o ssi b le

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P T AC C o l l aborative M i ssion, P u rp o se and C o rnerstone Mis s ion – T o strat eg ic a l l y w i d e n c o mm un ity beha vi o r a l hea lth an d s o ci a l serv i ce o p tio n s av a i l a b le thr o u g h l a w e n forc e me n t d i vers i on Purp o se – T o pr o vi d e n a tio n al vis i o n , l e a d ers h i p , vo i ce, a n d acti o n to r e frame t h e re la ti on s h ip be t w ee n l a w en forc e m en t, tr ea tme n t, a n d comm u n i ty Corne r stone – P T AC is ope n as to w h i ch mo d e l /br a nd of pr e -arr e st d i vers i on is a p pr o pr i ate for a j u ris d icti o n; e a ch comm u n i ty must d e termi n e w h i ch a p pr o ach so l ves its p r ob l e m , fits the l o c a l sit ua ti on , an d c a n be a dd r e ss e d thr o u g h curr e nt b e h a vi o ral h e a l th ca p ac i ty

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P T AC C o l l aborative Fo u nding Partners

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